Effectiveness of great toenail bed flap supplied with fibular dorsal artery of great toe for finger nail bed central longitudinal defect / 中国修复重建外科杂志

Objective: To explore the surgical method and effectiveness of the great toenail bed flap supplied with the fibular dorsal artery of great toe in repair of the finger nail bed central longitudinal defect. Methods: Between May 2012 and February 2017, 7 cases (7 fingers) with the finger nail bed central longitudinal defects were repaired with the great toenail bed flap supplied with the fibular dorsal artery of great toe. There were 3 males and 4 females; the age ranged from 17 to 35 years (mean, 27 years). The cause of injury included cutting injury in 2 cases, electric shaving injury in 3 cases, and frictional injury in 2 cases. The defect located at thumb in 3 cases, index finger in 3 cases, and middle finger in 1 case. The defect area ranged from 12 mm×8 mm to 21 mm×13 mm. The time from injury to admission was 1-2 hours (mean, 1.5 hours). The area of the great toenail bed flap ranged from 14 mm×10 mm to 23 mm×15 mm. The wound of donor site was directly sutured in 3 cases and repaired with full thickness skin graft in 4 cases. Results: All the great toenail bed flaps and skin grafts at the donor sites survived; and all wounds healed by first intention. All patients were followed up 9 to 36 months (mean, 23 months). The finger nails were smooth and shiny and recovered ideal appearance. At 9 months after operation, the two-point discrimination of the skin ranged from 7 to 9 mm (mean, 8 mm). According to the standard evaluation for nail bed repair issued by Zook etc., 6 cases were rated as excellent and 1 case as good, and the excellent and good rate was 100%. Conclusion: It is an ideal method to repair the finger nail bed central longitudinal defect with the great toenail bed flap supplied with the fibular dorsal artery of the great toe.

A Case Report of Nail Bed Reconstruction with Digital Artery Perforator (DAP) Flap and Buccal Mucosal Graft

PURPOSE: Many fingertip injuries are associated with nail injury and it is hard to repair to original shape due to its unique characteristic. Mucosal graft is used for a defect of the nail bed injury. Hereby, we introduce a DAP flap and buccal mucosal graft, with which we could reduce the defect size of the injured fingertip and donor site morbidity at the same time, without any need for harvesting additional skin from other part of hand. Also, mucosal graft makes good cosmetic and functional outcome of nail. METHODS: This method was performed in a 56-year-old man with fingertip injury on dorsal side of left thumb due to electrical saw. First, DAP flap was performed on the injured finger to reduce the size of the defect of fingertip and cover the bone exposure. Second, nail bed part of the DAP flap was de-epithelized and buccal mucosal graft was done from left side of intraoral cavity wall. RESULTS: Flap and graft survived without any necrosis but some nail bed could not be covered with flap due to insufficient flap size. All wounds healed well and did not present any severe adversary symptoms. CONCLUSION: DAP flap with mucosal graft is an effective method that we can easily apply in reconstruction of fingertip injury. We suggest that the combination of the two procedures makes good functional and cosmetic outcome compared to the usual manner, especially in cases of nail bed injury without distal phalanx bone defect.

Adhesive Silicone Gel Sheet for Treatment of Nailbed Injury

If autogenous nail is lost in nail bed injuries, alternative effective nail bed protection material is questionable in postoperative follow up period. The conventional modality with autogenous nail coverage have several disadvantages such as drawback of maintenance, higher chance of loss and complex dressing step (eg. ointment apply for humidification and nail fixation using tape or bandage). So, we have studied the usefulness of adhesive silicone gel sheet for alternative nail bed protection material until the end of nail regeneration. From March 2003 to July 2004, we have experienced 215 traumatic nail bed injuries except fingertip loss. Among these patient, we classified two groups, 30 cases with autogenous nail protection(Group I) and 30 cases with adhesive silicone gel sheet protection(Group II). Mean full nail growth time was 3.6 months in group I and 3.8 months in group II. Mean final nail appearance score(0: poor, 4: excellent) was 3.0 in group I and 3.5 in group II. Adhesive silicone gel sheet protection(Group II) was slightly superior to the autogenous nail protection in final appearance, especially sterile matrix laceration. In conclusion, we believe that adhesive silicone gel sheet application is a simple, acceptable, alternative method for protecting nail bed with loss of autogenou nail. It has a number of advantages compared with autogenous nail such as better humidification, controllable hygiene, less pain, less hospitalization, less frequent visit, less chance of loss, avoiding complex dressing step and more even pressure with adhesiveness, flexibility and durability.